Union study in China shows smoking cessation activities have long-term impact on people who underwent TB treatment

A Union-led study, published in the September issue of Tobacco Induced Diseases, described changes in smoking status among people who underwent tuberculosis (TB) treatment five years previously, to determine the impact of smoking cessation advice and counselling. The findings confirmed that participants who received the cessation intervention maintained higher non-smoking rates compared with those who did not receive the intervention.

For many years it has been known that tobacco smoking is an independently confirmed risk factor for TB infection, TB disease and mortality. Smoking is also a risk factor for delays incurred by people with TB in accessing health services and is associated with increased risk of drug-resistant TB. Despite the body of evidence, and the fact that the World Health Organization (WHO) End TB Strategy and The Union call for global action on the co-management of TB and comorbidities, smoking cessation is not a prominent component of National TB Programmes in most low- and middle-income countries.

To meet the operational requirement behind this identified need, The Union published guidelines on tobacco cessation interventions for TB patients in 2010, and implemented them in China. Although good cessation rates were achieved immediately after the completion of TB treatment, the results were not implemented nationwide because a lack of longer-term data. In total, 800 TB patients were registered at the beginning of March 2010, completing their anti-TB treatment by November 2011.

The recently-published study was therefore a follow-up, having been conducted five years after the completion of anti-TB treatment, assessing changes in the participants’ smoking status against the individual baseline data obtained at the time of TB registration. Of the 800 initially registered TB patients, 650 were found and visited.

This study’s findings on smoking status five years after completion of anti-TB treatment, showed that non-smokers, ex-smokers and current smokers who received the cessation intervention at baseline maintained higher non-smoking rates than those who did not benefit from the intervention. An additional observation was that that being ≥65 years of age, and patients being registered in a TB clinic not implementing a smoke-free policy, were independently confirmed risk factors for smoking relapse.

The findings suggest an urgent need to include smoking cessation and a smoke-free health facility policy as an integral part of TB services, with intensive cessation support being given to people with TB aged ≥65 years of age.